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Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study

BACKGROUND: Recent changes to diagnostic criteria for depression in DSM-5 remove the bereavement exclusion, allowing earlier diagnosis following bereavement. Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists...

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Autores principales: Shah, Sunil M., Carey, Iain M., Harris, Tess, DeWilde, Stephen, Victor, Christina R., Cook, Derek G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818377/
https://www.ncbi.nlm.nih.gov/pubmed/24223722
http://dx.doi.org/10.1371/journal.pone.0077734
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author Shah, Sunil M.
Carey, Iain M.
Harris, Tess
DeWilde, Stephen
Victor, Christina R.
Cook, Derek G.
author_facet Shah, Sunil M.
Carey, Iain M.
Harris, Tess
DeWilde, Stephen
Victor, Christina R.
Cook, Derek G.
author_sort Shah, Sunil M.
collection PubMed
description BACKGROUND: Recent changes to diagnostic criteria for depression in DSM-5 remove the bereavement exclusion, allowing earlier diagnosis following bereavement. Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement. AIMS: To describe initiation of psychotropic medication in the first year after partner bereavement. METHODS: In a UK primary care database, we identified 21,122 individuals aged 60 and over with partner bereavement and no psychotropic drug use in the previous year. Prescribing (anxiolytic/hypnotic, antidepressant, antipsychotic) after bereavement was compared to age, sex and practice matched controls. RESULTS: The risks of receiving a new psychotropic prescription within two and twelve months of bereavement were 9.5% (95% CI 9.1 to 9.9%) and 17.9% (17.3 to 18.4%) respectively; an excess risk of initiation in the first year of 12.4% compared to non-bereaved controls. Anxiolytic/hypnotic and antidepressant initiation rates were highest in the first two months. In this period, the hazard ratio for initiation of anxiolytics/hypnotics was 16.7 (95% CI 14.7 to 18.9) and for antidepressants was 5.6 (4.7 to 6.7) compared to non-bereaved controls. 13.3% of those started on anxiolytics/hypnotics within two months continued to receive this drug class at one year. The marked variation in background family practice prescribing of anxiolytics/hypnotics was the strongest determinant of their initiation in the first two months after bereavement. CONCLUSION: Almost one in five older people received a new psychotropic drug prescription in the year after bereavement. The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5. Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use.
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spelling pubmed-38183772013-11-09 Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study Shah, Sunil M. Carey, Iain M. Harris, Tess DeWilde, Stephen Victor, Christina R. Cook, Derek G. PLoS One Research Article BACKGROUND: Recent changes to diagnostic criteria for depression in DSM-5 remove the bereavement exclusion, allowing earlier diagnosis following bereavement. Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement. AIMS: To describe initiation of psychotropic medication in the first year after partner bereavement. METHODS: In a UK primary care database, we identified 21,122 individuals aged 60 and over with partner bereavement and no psychotropic drug use in the previous year. Prescribing (anxiolytic/hypnotic, antidepressant, antipsychotic) after bereavement was compared to age, sex and practice matched controls. RESULTS: The risks of receiving a new psychotropic prescription within two and twelve months of bereavement were 9.5% (95% CI 9.1 to 9.9%) and 17.9% (17.3 to 18.4%) respectively; an excess risk of initiation in the first year of 12.4% compared to non-bereaved controls. Anxiolytic/hypnotic and antidepressant initiation rates were highest in the first two months. In this period, the hazard ratio for initiation of anxiolytics/hypnotics was 16.7 (95% CI 14.7 to 18.9) and for antidepressants was 5.6 (4.7 to 6.7) compared to non-bereaved controls. 13.3% of those started on anxiolytics/hypnotics within two months continued to receive this drug class at one year. The marked variation in background family practice prescribing of anxiolytics/hypnotics was the strongest determinant of their initiation in the first two months after bereavement. CONCLUSION: Almost one in five older people received a new psychotropic drug prescription in the year after bereavement. The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5. Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use. Public Library of Science 2013-11-05 /pmc/articles/PMC3818377/ /pubmed/24223722 http://dx.doi.org/10.1371/journal.pone.0077734 Text en © 2013 Shah et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Shah, Sunil M.
Carey, Iain M.
Harris, Tess
DeWilde, Stephen
Victor, Christina R.
Cook, Derek G.
Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study
title Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study
title_full Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study
title_fullStr Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study
title_full_unstemmed Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study
title_short Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study
title_sort initiation of psychotropic medication after partner bereavement: a matched cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818377/
https://www.ncbi.nlm.nih.gov/pubmed/24223722
http://dx.doi.org/10.1371/journal.pone.0077734
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